Dear Therapist:

I am writing in regard to some of the questions that have come up in the column recently as to when there is an indication of a mental health issue for a bochur or child. I once heard that a good measure of evaluation is if the problem is happening across the board at home, school and camp that would be a sign that professional intervention is needed. If the child is fine at home and elsewhere and only having a problem in yeshiva most probably it is not mental health. Mental health problems usually are noticed across the board. I was wondering what the panelists think of using that as a measure of what constitutes needing professional intervention?

Response:

There are three concepts that you referenced in your question: mental health, mental health problems, and the necessity for professional intervention. Mental health refers simply to the ways in which a person’s thoughts, beliefs, feelings, and actions function and interact with one another. Mental health problems are maladaptive thoughts, beliefs, feelings, or actions—or a combination thereof. Professional intervention can be a personal decision; sometimes its necessity becomes obvious.

Your question refers to when professional intervention is necessary. It is true that one evaluation measure is in which areas of life a person’s issues are affecting them. However, this is only one measure. In order to determine whether intervention is required, there are a number of factors. One factor is the person’s subjective level of distress. Another is their level of functioning. For someone who is not trained in assessment and treatment, it can be difficult to identify these factors and to properly determine the necessity for treatment.

One prime consideration is the source of any issue. If, for instance, someone is having difficulty only in school, there can be many causes for this. It can be due to lack of interest or preoccupation with other things. Or it can be due to an emotional problem. If this is the case, the longer the issue goes unaddressed the harder it will typically be for the person to resolve it. It requires much training and experience to properly determine likely causes and underlying issues.

Another thing to consider is the fact that problems relating to underlying emotions tend to metastasize. Over time, an issue that initially manifests itself only in the school setting can easily bleed over to other areas of life. Unfortunately, many people tend to ignore issues until this has occurred. This begs the question: Do we really want to wait until a problem is entrenched and pervasive, perhaps requiring longer term and more intensive intervention?

Even in cases where professional intervention is not strictly necessary, is there an advantage in allowing a problem to continue? If someone truly has a relatively minor issue only in school, is it better to leave it alone or to try and help them to resolve it? There are times when professional intervention is necessary and times when it is advised. There may be times when it is not appropriate—but this would be largely based on the particular circumstance (family, stigma, etc.).

Though becoming “addicted” to therapy has been raised as a concern, this is something that a competent therapist will do their best to help clients avoid. When someone sees a therapist for a relatively minor issue, short-term treatment is usually the goal. Generally speaking, the determination as to whether to seek help should be based on whether the likely benefits of seeing a therapist outweigh any possible detriments.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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